口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响

目的 分析比较美国癌症联合委员会（AJCC）第8版与第7版TNM分期系统在口腔癌临床治疗决策、预后分层以及提高预后评价准确性中的意义。方法 收集2009年1月—2015年6月手术治疗的原发口腔鳞状细胞癌患者,分别应用第7版、第8版TNM分期系统对肿瘤进行分期,比较2种分期的变化情况。采用SPSS 26.0软件包,运用Kaplan-Meier法绘制生存曲线和Log-rank检验生存曲线间的差别情况,计算各分期系统的C指数及Akaike信息标准,比较2种分期模型预测精度、拟合数据的优良性。结果 随访570例患者,中位随访年龄64岁,中位随访时间38个月。第8版分期系统使得146例（25.61%）患者原有肿瘤分期发生了改变。T分期、TNM分期的总体生存和疾病别生存模型分析,第8版的AIC值均显著小于第7版,C指数均显著大于第7版（P<0.05）。结论 口腔癌AJCC第8版TNM分期增加了浸润深度和淋巴结结外扩展2个指标,2个指标使按原标准分期的许多患者的病理分期发生了改变。浸润深度为6.25 mm时,可以很好地预测淋巴结转移性病变,亦是预测总体生存和疾病别生存的最佳界值。新版分期系统对口腔癌患者,尤其是晚期患者的临床决策、预后评价更具有指导意义。

Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation

PURPOSE: To analyze and compare the significance of the American Joint Committee on Cancer(AJCC eighth edition and seventh edition of TNM staging system in clinical treatment decision-making, prognosis stratification and improving the accuracy of prognosis evaluation of oral cancer. METHODS: A retrospective cohort study of patients with oral squamous cell carcinoma(OSCC) from 2009 to 2015 was performed, and AJCC seventh and eighth edition of stag-ing systems was applied to all patients. Overall survival and disease-specific survival were analyzed by Kaplan-Meier analysis and Log-rank test with SPSS 26.0 software package. Concordance index and Akaike information criterion was used to calculate the system’s prognostic accuracy. RESULTS: In total, 570 patients were followed up with a median follow-up age of 64 years. The median follow-up peroid was 38 months. The tumor stage of 146(25.61%) patients was changed by depth of invasion and extranodal extension. Overall survival and disease-specific survival model analysis of T stage and TNM stage showed that the Akaike information criterion of AJCC eighth edition staging systems was significantly lower than the seventh edition and concordance index was significantly higher than the seventh edition( P<0.05). CONCLUSIONS: Depth of invasion and extranodal extension were added to the TNM staging of oral cancer in the AJCC eighth edition of staging systems. These two indices have changed the pathological stages of many patients according to the original standard staging. The results showed that when depth of invasion is 6.25 mm, it can well predict cervical lymph node metastasis, and is also the optimal cut-off for predicting overall survival and disease-specific survival. The new staging system has more guiding significance for clinical decision-making and prognosis evaluation of oral cancer patients, especially for advanced patients.